As reported by The Times, the Prime Minister has told his Health Secretary, Yvette Cooper, that additional funding for patient care must be found in existing NHS budgets. For once, allow me to praise Mr Burnham: this is the kind of financial discipline the health service has needed for decades.
The NHS has enjoyed so many “record funding settlements” that the phrase has become devoid of all meaning. In England alone, it spends more than £200 billion per year — enough to build HS2 and Heathrow’s third runway and be left with £70bn in change. And what have patients received in return? They are more likely to die of cancer than Colombians or Costa Ricans. It’s little wonder 59 per cent of the public believe reforming the NHS should take priority over increasing its funding.
Health officials, however, keep prescribing the same remedy. “Anonymous Whitehall sources” briefed The Times that Burnham’s refusal to open his wallet will pile pressure on hospitals as winter approaches. As a speechwriter to successive health secretaries, I’ve seen this movie before. Whenever the NHS faces a spending squeeze, civil servants present ministers with a binary choice: spend more money or watch patient care deteriorate. Their argument has a powerful moral pull — no minister wants to accept more deaths or longer waiting times — but this framing conveniently omits another option: reforming the NHS’s culture to put patients first.
Join Britain’s most civilised publication.
Challenge the consensus. Access rigorous analysis.
That may sound like an absurd statement — of course the NHS is there for patients, that’s why we all banged our pots and pans in Covid! That, however, would be a misremembering of the pandemic’s narrative. We were ordered to stay at home not to protect one another, but to protect the NHS. And it’s no coincidence that its productivity has never recovered from those strange times. For while we were all locked in our living rooms, George Floyd’s death allowed the virus of identity politics to capture the British state — and the NHS with it.
Walk into a hospital today and you will soon learn who is in charge. Signs warning you not to abuse or discriminate against staff are plastered across the walls. You’re reminded that delays and cock-ups must be taken on the chin, lest your comments threaten their wellbeing. Lancashire Teaching Hospitals reserves the right to withhold treatment from patients who swear, engage in “loud and intrusive conversation” or display “unreasonable behaviour”. At the Royal National Orthopaedic Hospital, adopting an “aggressive, forceful tone” that “upsets staff” can see you out on your ear, and your social media posts could be cited as evidence against you.
This architecture of victimhood does not maintain itself, and new FOI disclosures show how thoroughly identity politics has distorted the NHS’s priorities. NHS England, the behemoth quango charged with overseeing the health service, runs 12 staff networks — from the usual BAME, LGBTQIA+ and Muslim networks to the curiously branded “multiKultural” network.
The BAME network held monthly “drop-in” sessions — something that, in my experience, translates to “having a cup of tea and a grumble”. Their LGBTQIA+ colleagues put their knowledge to the test with four quizzes in seven months, culminating in “The Big Fat Gay Quiz 2!” They also served “Lesbian Afternoon Tea” between 2.30 and 3.30pm on a Thursday — it is the new Friday, after all. A workshop entitled “Building Bridges: LGBTQIA+ Inclusion Workshop” took up two and a half hours of the working day, only to be repeated three and a half months later. Not to be left out, the multiKultural network provided a “safe space” for members to share their “lived experience” of the NHS’s reorganisation programme and held an hour-long “Active Bystander Session”.
The number of staff attending these events, however, was not routinely recorded. Three BAME network events featuring guest speakers attracted 650 attendees between them and, if each one stayed for the duration, would have consumed more than 500 working hours. Yet NHS England listed all three events as involving “no additional expenses”. A sleight of hand that conceals the opportunity cost of diverting working time towards the pursuit of identity politics.
In a similar vein, NHS England’s FOI response said it did not “formally allocate contracted time” to network activity. A curious claim given the BAME network’s terms of reference require each of its nine officers to commit at least one day a week to network activities. Equivalent documents for the menopause network describe an administrator paid for four hours’ work each week to manage its inbox, membership requests and meeting invitations. More generous still is the organisation-wide guidance appended to the multiKultural network’s terms of reference. It suggests network members and chairs can receive up to 30 per cent of their working week for network duties, with “appropriate backfill” for their day jobs. A provision that, if used, would leave taxpayers paying two salaries for one job.
These networks also form an alternative bureaucracy. The BAME network’s terms of reference explicitly commit it to “influence policy making and monitor existing policies, practices and behaviours”. multiKultural, meanwhile, has its own leads for data, communications, “Policy & Transformation” and equality, diversity and inclusion. A diversity officer for a diversity network, there’s someone I’d like to get to know. But, in all seriousness, the NHS’s policies ought to be shaped by patients’ needs, not the preoccupations of unrepresentative and self-selecting staff groups.
The problem is as stark at the trust level. A further FOI reveals that in October 2024 Great Ormond Street Hospital paid £6,600 to Radius, a specialist provider of staff network training, for a package including ten places on its Employee Network Leadership Programme. Nearly two years later, only one person had completed a course and six places remained unused. According to their brochures, Radius — who provide services to other trusts — offer network leaders lessons in finding their voice on social media, “holding stakeholders accountable”, “engaging external communities” and “Founding spin-off networks”. Taxpayers’ money is being used to expand these groups’ membership, reach and influence.
Health chiefs cannot credibly threaten cuts to patient care while treating diversity spending as untouchable
Just one trust — Wrightington, Wigan and Leigh — spent £162,942 on EDI training, events and consultancy in 2024/25 alone, while a number of trusts publicly advertise allowing network officers to carry out their duties during the working week. This patchwork of training, subscriptions to outside bodies and paid time for network officers disappears into individual trust budgets, ensuring no national total exists and each individual sum appears too small to challenge. This is how identity politics becomes institutionally permanent.
Health chiefs cannot credibly threaten cuts to patient care while treating diversity spending as untouchable. Ministers must have the gumption to challenge their sophistry and the Prime Minister must hold firm against the lobbying that will ratchet up as winter approaches. He might begin his new era of fiscal rectitude by explaining to a constituent stuck on a waiting list how “The Big Fat Gay Quiz 2!” passes the Makerfield test.